That the following question(s) of law is/are pending in my case/in the case of ................................ .......................................................................... before the **High Court/Supreme Court on a reference under section 27

[see rule 113] Form for intimating non-availability of information under clause (b) of sub-section (1) of section 138 of the Income-tax Act, 1961 No. ................................

[See rule 18BBA(7)1 Report under section 80HHE (4)/ 80HHE(4A) of the Income-tax Act, 1961 1. I/We have examined the accounts and records of ....................................……………………………… [name and address of the assessee with permanent account number]

[See clause (c) of sub-rule (4) of rule 2D] Condensed financial information Income statement  YEARS First Year Second Year Third Year (Mention years also)

Information to Be furnished to the income-tax authority under section 133B of the Income-tax Act, 1961 1. Name, address and telephone No. of the business/profession

To The Secretary, Central Board of Direct Taxes, New Delhi. The petition of ................................. employer(s) carrying

The Secretary, Central Board of Direct Taxes, New Delhi

I, ....................................…………………………, do hereby declare that what is stated above is true to the best of my knowledge and belief.

The application for settlement must be in quintuplicate. The application for settlement must be accompanied by a fee of five hundred rupees. The fees should be credited in a branch of the authorised bank or branch of the Reserve Bank of India

To The Secretary, Central Board of Direct Taxes, New Delhi.

Certificate under section 203 of the Income-tax Act, 1961 for tax deducted at source from income chargeable under the head “Salaries” Name and address of the Employer Name and designation

Details of income referred to in section 194D credited/paid during the financial year and of tax deducted at source at the prescribed rates in force :

Sir, This is to state that the property, particulars of which are given hereunder, is held by

Communication under clause (b) of Explanation below section 185(1) of the Income-tax Act, 1961, regarding partner who is a benamidar To The Assessing Officer, ………………………….

APPELLANT  RESPONDENT 1. The  State/Union territory in  which  the  office  of  the  competent au- thority passing the order appealed against is situate

Has address of the person responsible for paying any income by way of winnings Tick as applicable Yes           No. From horse race changed since submitting the last return 

© Has address of the person responsible for paying any commission   Tick   as applicable Yes           No. or brokerage referred to in section 194H changed since submitting the last return

I, ., certify that all the particulars furnished above are correct and complete. Place: Name and signature of the responsible for deducting tax at source

Place: Name and signature of the person responsible for deducting tax at source... Date: Designation 

[I, ................(name in full and block letters) **son/daughter/wife/karta/member of Hindu undivided family hereby declare that what is stated is true to the best of my knowledge and belief.